The DHS Program

March 27, 2009 
Declines in fertility and childhood mortality: Good news from the 2007 Bangladesh DHS

Dhaka, Bangladesh. Women are having fewer children, and these children are more likely to survive their early years, according to the newly released 2007 Bangladesh Demographic and Health Survey (BDHS). Improvements in education, family planning and health are reported in the new survey although progress is delayed in maternal health and child nutrition. The BDHS visited 10,400 households and interviewed almost 11,000 women and 4,000 men.

Fertility has declined in recent years. On average, women in Bangladesh have 2.7 children, down from 3.0 children in 2004 and 3.3 in 1999-2000. According to these new findings, the total fertility rate in Bangladesh is the same as in India and lower than other countries in Asia—Pakistan, the Philippines, Cambodia, and Nepal.  

Fertility varies by division, ranging from a low of 2.0 children per woman in Khulna to a high of 3.2 in Chittagong and 3.7 in Sylhet. Urban women and highly educated women have fewer children than their rural and less educated counterparts. The poorest women have an average of 3.2 children compared to 2.2 children among women from the wealthiest households.

More young women are now going to school and waiting longer to have their first child—practices which may have contributed to the decline in fertility. The percent of girls age 15 to 19, with some secondary education has jumped from 5 percent in 1993-94 to 61 percent in 2007. Only 10 percent of young women have no education, down from 12 percent in 2004 and 20 percent in 1999-200. The median age at first birth has increased by a full year—from 18 in 2004 to 19 in 2007—although the median age at marriage has not changed.

Use of modern contraceptives has remained steady at 48 percent of married women, although knowledge of family planning methods is universal. Family planning use is very uneven in Bangladesh. Only 25 percent of married women in Sylhet, the division with the highest fertility rate, use modern methods compared to more than 50 percent in Khulna and Rajshahi. The pill is by far the most popular method followed by injectables. Overall, less than 8 percent of women rely on long-term and highly effective methods like the IUD and sterilization.

The decline in early child deaths is one of the notable accomplishments reported by the new survey. Currently, only one of every 15 Bangladeshi children dies before reaching age five, down from one in 11 in 2004. The current infant mortality rate (deaths within the first year of life) has also declined from 65 deaths per 1,000 live births in 2004 to 52 deaths in 2007. Deaths in the first month of life have also declined, although only slightly.

Despite these encouraging results, Bangladeshi children are still struggling with frequent illness and poor nutrition. One in 10 children experienced recent episodes of diarrhea, and almost 38 percent recently had a fever, according to the survey. The majority of these children were treated at home and not by a trained provider. Malnutrition is disturbingly common. Stunting (the child is too short for his age) which indicates chronic malnutrition, has declined since 2004, at present, 43 percent of Bangladeshi children under 5 are stunted) Just over 4 in 10 children (41 percent) are underweight, and 17 percent of children are wasted, or too thin for their height.

Care for women during pregnancy and childbirth has changed only slightly since 2004. Just half of pregnant women get any antenatal care from a skilled provider, and only 21 percent receive the recommended four or more visits. Four in ten pregnant women receive no care at all. Far fewer women are assisted at childbirth by a medically trained provider. The majority of women give birth at home with help from an untrained traditional birth attendant, putting both the woman and her child at risk. While births in health care facilities have increased from 9 percent in 2004, to 15 percent of women in 2007, 85 percent of births still take place at home. Most women who give birth in health facilities choose to go to private services. Of great concern is the two-thirds of women giving birth in private facilities are delivered by Caesarean section, which increases both health risks and costs.

Violence against women is disturbingly common, according to the survey. Almost half of all ever-married women experienced physical violence at the hands of their husbands, and 18 percent reported sexual violence. One in four women was subject to physical and/or sexual violence in the past 12 months. Women’s reports were matched by responses from men. Almost 60 percent of ever-married men said that they had ever committed physical violence against their wives, and 16 percent had done so in the past 12 months. Spousal violence is more common among the poorest and least educated households. For example, 62 percent of women with no education had experienced violence compared to 36 percent among women with secondary complete or higher education.  

The 2007 Bangladesh DHS is the fifth national survey carried out as part of the Demographic and Health Surveys project in Bangladesh. The 2007 Bangladesh DHS was carried out by the National Institute for Population Research and Training (NIPORT) of the Ministry of Health and Family Welfare. The survey was implemented by Mitra and Associates, a Bangladeshi research firm located in Dhaka. Macro International Inc. provided technical assistance to the survey as part of its international Demographic and Health Surveys program. The U.S. Agency for International Development (USAID) provided financial assistance.

Additional information about the 2007 BDHS may be obtained from (NIPORT), Azimpur, Dhaka, Bangladesh; Telephone: 862-5251; Fax: 861-3362 or from Mitra and Associates, 2/17 Iqbal Road, Block A, Mohammadpur, Dhaka, Bangladesh; Telephone: 911-5053; Fax: 912-6806.